Robotized system for femoroacetabular impingement resurfacing

ABSTRACT

Systems and methods are described herein for resurfacing bones, and in particular, for detecting and resurfacing one or more femoroacetabular impingements (FAIs). A FAI resurfacing controller may be used to perform this detecting and resurfacing of FAIs. The FAI resurfacing controller may include a bone model generator to receive bone imaging and to generate a model of at least one osteophyte and of a surface of a native bone surrounding the at least one osteophyte. The FAI resurfacing controller may include an osteophyte identifier to set a virtual 3D boundary surface between native bone surface and the at least one osteophyte. The FAI resurfacing controller may include a resurfacing navigator to generate and output a navigation file. The navigation file may include the model with the 3D boundary surface between native bone surface and the at least one osteophyte.

CLAIM OF PRIORITY

This application is a divisional of U.S. patent application Ser. No.16/786,522, filed Feb. 10, 2020, which is a divisional of U.S. patentapplication Ser. No. 15/625,555, filed on Jun. 16, 2017, now issued asU.S. Pat. No. 10,582,971, which claims the benefit of U.S. ProvisionalPatent Application Ser. No. 62/350,891, filed on Jun. 16, 2016, thebenefit of priority of each of which is claimed hereby, and each ofwhich is incorporated by reference herein in its entirety.

FIELD

The present application relates to computer-assisted orthopedic surgeryinvolving robotized apparatuses.

BACKGROUND

Computer-assisted surgery has been developed to help an operator inaltering bones, and in positioning and orienting implants to a desiredorientation. Among the various tracking technologies used incomputer-assisted surgery, optical navigation, C-arm validation, andmanual reference guides have been used. The optical navigation typicallyrequires the use of a navigation system, which adds operative time.Moreover, the optical navigation is bound to line-of-sight constraintsthat hamper the normal surgical flow. C-arm validation requires the useof bulky equipment, and the C-arm validation is not cost-effective.

Such tracking technologies often assist manual work performed by anoperator or surgeon. While surgeons may have developed an expertise inmanipulations performed during surgery, some practitioners prefer theprecision and accuracy of robotized surgery.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic view of a robotized surgery system, in accordancewith some embodiments.

FIG. 2 is an exemplary perspective view of a foot support of therobotized surgery system of FIG. 1 , in accordance with someembodiments.

FIG. 3A is a perspective schematic view of femoroacetabular impingement(FAI) conditions on the pelvis, in accordance with some embodiments.

FIG. 3B is a perspective schematic view of FAI conditions on the femoralhead and neck, in accordance with some embodiments.

FIG. 4 is a block diagram of a FAI resurfacing controller used with therobotized surgery system of FIG. 1 , in accordance with someembodiments.

FIG. 5 illustrates a flow chart showing a robotized surgery systemtechnique for FAI resurfacing, in accordance with some embodiments.

FIG. 6 illustrates generally an example of a block diagram of a machineupon which any one or more of the techniques (e.g., methodologies)discussed herein may perform in accordance with some embodiments.

DETAILED DESCRIPTION

The present disclosure describes a robotic system for resurfacing bones,and in particular, for detecting and resurfacing one or morefemoroacetabular impingements (FAIs). A FAI resurfacing controller maybe used to perform this detecting and resurfacing of FAIs. The FAIresurfacing controller may include a bone model generator to receivebone imaging and to generate a model of at least one osteophyte and of asurface of a native bone surrounding the at least one osteophyte. TheFAI resurfacing controller may include an osteophyte identifier to set avirtual 3D boundary surface between native bone surface and the at leastone osteophyte. The FAI resurfacing controller may include a resurfacingnavigator to generate and output a navigation file. The navigation filemay include the model with the 3D boundary surface between native bonesurface and the at least one osteophyte. The navigation file may alsoinclude patient-specific numerical control data for resurfacing the boneto remove the at least one osteophyte.

In the drawings, which are not necessarily drawn to scale, like numeralsmay describe similar components in different views. Like numerals havingdifferent letter suffixes may represent different instances of similarcomponents. The drawings illustrate generally, by way of example, butnot by way of limitation, various embodiments discussed in the presentdocument.

FIG. 1 is a schematic view of a robotized surgery system 10, inaccordance with some embodiments. Robotized surgery system 10 may beused to perform orthopedic surgery maneuvers on a patient, such as FAIresurfacing, arthroscopy, or other surgical procedures. The robotizedsurgery system 10 is shown relative to a patient's leg in a supinedecubitus, though the patient may be in lateral decubitus (e.g., toexpose the hip joint) or in another position.

The robotized surgery system 10 may include a robot arm 20, a footsupport 30, a thigh support 40, a robotized surgery controller 50, a FAIresurfacing controller 60, and a supplementary tracking apparatus 70.The robot arm 20 is the working end of the system 10, and is used toperform bone alterations as planned by an operator and as controlled bythe robotized surgery controller 50. The robot arm 20 is positioned toaccess the hip joint of the patient for performing FAI resurfacing. Thefoot support 30 supports the foot and lower leg of the patient, in sucha way that it is only selectively movable for adjustment to thepatient's position and morphology. The thigh support 40 supports thethigh and upper leg of the patient, again in such a way that it is onlyoptionally movable. The thigh support 40 may assist in keeping the hipjoint fixed during FAI resurfacing, and should hence be positioned so asnot to impede the movements of the robot arm 20. The robotized surgerycontroller 50 controls the robot arm 20. The FAI resurfacing controller60 output data used to drive the robot arm 20 in performing the FAIresurfacing. The tracking apparatus 70 may optionally be used to trackthe robot arm 20 and the patient limbs.

The robot arm 20 may stand from a base 21, for instance in a fixedrelation relative to the operating room (OR) table supporting thepatient. Indeed, the relative positioning of the robot arm 20 relativeto the patient is a determinative factor in the precision of thesurgical procedure, whereby the foot support 30 and thigh support 40 mayassist in keeping the operated limb fixed in the illustrated {X Y Z}coordinate system. The robot arm 20 has a plurality of joints 22 andlinks 23, of any appropriate form, to support a tool head 24 thatinterfaces with the patient. The arm 20 is shown being a serialmechanism, arranged for the tool head 24 to be displaceable insufficient degrees of freedom (DOF). For example, the robot arm 20controls 6-DOF movements to the tool head 24, {X Y Z} in the coordinatesystem, and pitch, roll, and yaw. Fewer or additional DOFs may bepresent. For simplicity, only a generic illustration of the joints 22and links 23 is provided, but more joints of different types may bepresent to move the tool head 24 in the manner described above. Thejoints 22 are powered for the robot arm 20 to move as controlled by thecontroller 50 in the six DOFs. Therefore, the powering of the joints 22is such that the tool head 24 of the robot arm 20 may execute precisemovements, such as moving along a single direction in one translationDOF, or being restricted to moving along a plane, among possibilities.Various types of robot arms 20 may be used, such as those described inU.S. patent application Ser. No. 11/610,728, incorporated herein byreference.

The tool head 24 may also comprise a chuck or like tool interface,typically actuatable in rotation. In FIG. 1 , the tool head 24 supportsa burr 26A, such as may be used during FAI resurfacing. The tool head 24may support other surgical tools, such as a registration pointer, areamer, a cannula, a reciprocating saw, or another surgical tool. Thevarious tools may be interchanged, whether with human assistance, or asan automated process. The installation of a tool in the tool head 24 maythen require some calibration to position the installed tool in the {X YZ} coordinate system of the robot arm 20. Various surgical proceduresmay be performed when tool head 24 is used with a cannula. In anexample, the robot arm 20 may be used to perform a robotically assistedarthroscopy procedure. A shaver, burr, suture applicator, or anothersurgical instrument may be operated through the cannula. The controller50 may target the cannula using sensors within the robot arm 20, such assensors used to detect position or rotation of various components of therobot arm 20. The controller 50 may target the cannula using one or morecameras mounted on the tracking apparatus 70.

Tracking apparatus 70 may include various types of tracking systemsdepending on the particular surgical application. For example, thetracking apparatus 70 may be used to track the robot arm 20 or othercomponents of the surgery system 10 using one or more image capturedevices (e.g., cameras). The tracking apparatus 70 may include anarthroscopic camera for viewing the surgical site in a minimallyinvasive manner. The tracking apparatus 70 may also be used to providevideo recognition and tracking-guided surgery procedures. For example,the controller 50 may use the tracking apparatus 70 to detect anunhealthy acetabular labrum, place the cannula in a predeterminedlocation, and stitch the acetabular labrum. The tracking apparatus 70can also include an associated controller or computing system toprocessing data received from various sensors (e.g., cameras, etc.) toprovide guidance to other components of the system. For example, in anoptical tracking scenario, the tracking apparatus 70 can include atleast two cameras coupled to a computing system that utilizes imagescaptured from the cameras to triangulate positions of tracked objects.In another example, the tracking apparatus 70 can include anarthroscopic camera and a computing device that receives image data andperforms image processing operations to segment information out of theimage data related to osteophyte removal.

The tracking apparatus 70 may also be used to verify removal of one ormore osteophytes. A primary source of error during surgical proceduresinvolving removal of osteophytes is the failure to completely remove theosteophyte, which may be due to the difficulty in determining how muchof an osteophyte has been removed. The controller 50 may use thetracking apparatus 70 and robot arm 20 to determine how much of theosteophyte has been removed and whether the osteophyte removal processis complete. In an example, a feedback mechanism may be used to indicatewhen the osteophyte has been removed. The feedback may include a greenlight, an audible feedback, a tactile feedback, or other feedback. Thedetermination of whether the osteophyte has been removed may be based onan image from the tracking apparatus 70, based on comparing the burr 26Alocation against a 3D model, based on manual leg manipulation andtracking range of movement through the tracking apparatus 70, or basedon another osteophyte removal confirmation.

The controller 50 may drive the robot arm 20 in performing the surgicalprocedure based on the planning achieved pre-operatively. The robotizedsurgery controller 50 runs various modules, in the form of algorithms,code, non-transient executable instructions, etc., to operate the system10 in the manner described herein. For example, the controller 50 mayinclude a robot driver module, where the robot driver module is taskedwith powering or controlling the various joints of the robot arm 20.Force feedback may be provided by the robot arm 20 to avoid damaging thesoft tissue or surrounding environment. The robotized surgery controller50 may have a processor unit to control movement of the robot arm 20.System 10 may include an interface 90 to provide information to theoperator. The interface 90 may include a display, a wireless portableelectronic device (e.g., phone, tablet), a speaker for audio guidance,an LED display, or other type of interface.

The controller 50 may be used to drive the robot arm 20 to avoid variouspredetermined soft tissues. In an embodiment, the controller 50 may usethe tracking apparatus 70 to detect a particular soft tissue and drivethe robot arm 20 to avoid that soft tissue. In an embodiment, thecontroller 50 may identify a safety zone, and may guide the robot arm 20to enforce a safety zone by avoiding performing surgical procedureswithin the safety zone during a surgical procedure. In various examples,the safety zone may include surrounding soft tissue, a native bonesurface of a patient, or a critical blood vessel (e.g., femoral artery,neck artery).

To preserve the fixed relation between the leg and the coordinatesystem, a generic embodiment of a foot support 30 is shown in FIG. 1 ,while one possible implementation of the foot support 30 is shown ingreater detail in FIG. 2 . The foot support 30 may be displaceablerelative to the OR table, to adjust to the patient, with the joints thenlockable once a suitable position is reached. The mechanism of the footsupport 30 may have a slider 31, moving along the OR table in the X-axisdirection. Joints 32 and links 33 may also be part of the mechanism ofthe foot support 30, to support a foot interface 34 receiving thepatient's foot.

The thigh support 40 may be displaceable relative to the OR table, to bebetter positioned as a function of the patient's location on the table,so as not to impede action of the robot arm 20. Accordingly, the thighsupport 40 is shown as including a passive mechanism, with variouslockable joints to lock the thigh support 40 in a desired position andorientation. The mechanism of the thigh support 40 may have a slider 41,moving along the OR table in the X-axis direction. Joints 42 and links43 may also be part of the mechanism of the thigh support 40, to supporta thigh bracket 44. A strap 45 can immobilize the thigh/femur in thethigh support 40. The thigh support 40 may not be necessary in someinstances.

The foot support 30 or the thigh support 40 may assist in keeping thebones fixed relative to the {X Y Z} coordinate system. For instance, thefixed relation may be required in instances in which no additionaltracking is present to assist the actions of the robot arm 20. However,the tracking apparatus 70 may provide intraoperative trackinginformation for the robot arm 20 and for the patient bones, in such away that some movement of the patient is permissible intraoperatively asthe movement is calculable and thus known in the {X Y Z} coordinatesystem.

The operation of the tracking apparatus 70 may depend on the informationwithin the navigation file C. For example, the tracking apparatus 70 mayassist in performing the calibration of the patient bone with respect tothe robot arm 20, for subsequent navigation in the {X Y Z} coordinatesystem. The tracking apparatus 70 may include two cameras to providestereoscopic (e.g., 3D) image data to optically identify and locateretro-reflective references 71A, 71B, and 71B to triangulate positionsof objects associated with the references. In an embodiment, thereference 71A is on the tool head 24 of the robot arm 20 such that itstracking allows the controller 50 to calculate the position and/ororientation of the tool head 24 and tool 26A thereon. In an example,reference 71A may be etched on a stable portion of a burr tool 26A. Thecontroller 50 may use information about the position of the tool head 24and the camera on the tracking apparatus 70 to adjust the camera tooptimize the collected images, such as adjusting camera position, cameraangle, camera distance from tool head 24, focal length, or other dynamiccamera adjustments. The tracking apparatus 70 may also include a robottracking arm, and the controller 50 may control the robot tracking armto adjust the camera position or perform other dynamic cameraadjustments. The robot tracking arm may be controlled independently orin conjunction with controlling the robot arm 20.

In addition to reference 71A on the tool head 24, references 71B and 71Cmay be fixed to the patient bones, such as the tibia for reference 71Band the femur for reference 71C. In an example, references 71B and 71Care applied to the patent bones using a brief procedure to provide rapidreference tracking. In another example, references 71B and 71C mayinclude application of a virtual marker (e.g., “painted on”) to an imageof the bone, such as using interface 90. In FAI resurfacing, it may onlybe necessary to have the reference 71C, although it may be desired tohave another reference on the pelvis as well, depending on the locationof the osteophytes. As shown, the references 71 attached to the patientneed not be invasively anchored to the bone, as straps or likeattachment means may provide sufficient grasping to prevent movementbetween the references 71 and the bones, in spite of being attached tosoft tissue. For example, the references 71 may include a fabricremovably and non-invasively attachable to a bone, where references 71each include a plurality of reference markers distributed on the surfaceof the fabric. The controller 50 continuously updates the position ororientation of the robot arm 20 and patient bones in the {X Y Z}coordinate system using the data from the tracking apparatus 70.Tracking system 70 may include one or more of optical tracking sensors,inertial tracking sensors, or other motion or location sensors. Forexample, tracking system 70 may include inertial sensors (e.g.,accelerometers, gyroscopes, etc.) that produce tracking data to be usedby the controller 50 to update the position or orientation of the robotarm 20 continuously. Other types of tracking technology may also beused.

The calibration may be achieved in the manner described above, with therobot arm 20 using a registration pointer on the robot arm 20, and withthe assistance of the tracking apparatus 70 if present in the robotizedsurgery system 10. Another calibration approach is to performradiography of the bones with the references 71 thereon, at the start ofthe surgical procedure. For example, a C-arm may be used for providingsuitable radiographic images. The images are then used for the surfacematching with the bone model B of the patient. Because of the presenceof the references 71 as fixed to the bones, the intraoperativeregistration may then not be necessary, as the tracking apparatus 70tracks the position or orientation of the bones in the {X Y Z}coordinate system after the surface matching between X-ray and bonemodel is completed.

FIG. 2 is an exemplary perspective view of a robotized surgery systemfoot support 30, in accordance with some embodiments. The foot interface34 may have an L-shaped body ergonomically shaped to receive thepatient's foot. To fix the foot in the foot support 33, differentmechanisms may be used, one of which features an ankle clamp 35. Theankle clamp 35 surrounds the rear of the foot interface 34, andlaterally supports a pair of malleolus pads 36. The malleolus pads 36are positioned to be opposite the respective malleoli of the patient,and are displaceable via joints 37, to be brought together and henceclamp onto the malleoli. A strap 38 may also be present to secure theleg in the foot support 30 further, for example by attaching to thepatient's shin. As an alternative to the arrangement of FIG. 2 , acast-like boot may be used, or a plurality of straps 38, provided thefoot is fixed in the foot support 33.

FIG. 3A is a perspective schematic view of FAI conditions on the pelvisD, in accordance with some embodiments. FIG. 3B is a perspectiveschematic view of FAI conditions on the femoral head F1 and neck F2, inaccordance with some embodiments. The system 10 is used to resurface thefemoral head F1 or neck F2, or to resurface the periphery of theacetabulum A1 in a FAI condition. The FAI condition may be caused by oneor more osteophytes on the rim of the acetabulum A1 or femoral head F1or neck F2. In FIG. 3A, osteophyte O1 is shown built up on the peripheryof the acetabulum A1, part of the pelvis D. This acetabular bone growthmay be known as a pincer deformity, and may cause a pincer impingement.In FIG. 3B, osteophyte O2 is shown built up at the junction of thefemoral head F1 and femoral neck F2, part of the pelvis D. This femoralbone growth may be known as a cam deformity, and may cause a femoral camimpingement. One or both of the pincer deformity and cam deformity mayoccur, and both may be corrected using the FAI resurfacing techniquesdescribed herein. FIGS. 3A and 3B are examples of possible osteophytelocations, but other osteophytes can build up at other locations.

FIG. 4 is a block diagram of a FAI resurfacing controller used with therobotized surgery system of FIG. 1 , in accordance with someembodiments. To drive the robot arm 20 in resurfacing the hip joint, ineither or both conditions of FIGS. 3A and 3B, a navigation file C may becreated. Referring to FIG. 4 , a FAI resurfacing controller is generallyshown at 60. The controller 60 may be part of the system 10, for exampleas part of a set of modules that are in the robotized surgery controller50. The FAI resurfacing controller 60 may also be a stand-aloneprocessing unit, used in pre-operative planning to prepare a navigationfile C.

The FAI resurfacing controller 60 may receive bone imagery B1. The boneimagery B1 may include a computed tomography (CT) scan image, magneticresonance imaging (MRI) image, or any other radiography imagery. A bonemodel generator module 61 receives the bone imagery B1 to generate abone model therefrom. The model may be a 3D representation of at least aportion of the surface having osteophytes thereon. For example, the 3Drepresentation may be that of a portion of the acetabulum A1 or of aportion of the femoral head F1 and neck F2. The 3D representation mayinclude a portion of the bone surface surrounding the osteophytes, andthe osteophytes.

An osteophyte identifier module 62 receives the bone model, and segmentsthe osteophyte from the native bone surface. Various approaches may beused for the segmentation by the osteophyte identifier module 62.According to an embodiment, the osteophyte identifier module 62 consultsa bone atlas database B2. The bone atlas database B2 includes acompilation of different femur or pelvis geometries, for instance alsoas 3D bone models. The osteophyte identifier module 62 compares the bonemodel, particularly the native bone surface surrounding the osteophyte,with bone geometries of the database B2 to find closest matches. Once aclosest match is identified, the bone models may be overlaid to define asurface of the patient bone covered by osteophytes.

Various geometric features may be used by the osteophyte identifiermodule 62 to identify an osteophyte. In an example, the received bonemodel may be used to identify geometric features of the bone, and theosteophytes may be identified by identifying differences between bonemodel geometric features and a bone atlas databases match. In anotherexample, one or more femoral or acetabular geometric measurements may beused to identify geometric features of the bone. The geometricmeasurements may include an alpha angle, a lateral center edge angle, afemoral head coverage, a sourcil angle, an acetabular angle, or otherfemoral or acetabular geometric measurements. In an example, the alphaangle may be used to characterize the concavity of the anterior femoralhead-neck junction, or how big the bump is on the femoral neck. Thealpha angle is defined as the acute angle between the femoral neck axisand a line between the femoral head center with the point where thehead-neck junction cortical surface first meets with a circlesuperimposed upon an ideally spherical femoral head. The alpha angle maybe particularly useful in detecting an osteophyte that causes orcontributes to a femoral cam impingement. In another example, thelateral center edge angle may be used to characterize the angularcoverage of the femoral head by the weight-bearing zone of theacetabulum. The lateral center edge angle is defined as the angle formedby intersection of a vertical line extending through the femoral headcenter and a line extending through the femoral head center to thelateral sourcil. The lateral center edge angle may be particularlyuseful in detecting an osteophyte that contributes to acetabulardysplasia, acetabular instability, or femoral impingement. In anotherexample, the femoral head coverage may be used to characterizeweight-bearing femoral head coverage, where the femoral head coverage isdefined as the percentage coverage of the femoral head by theweight-bearing zone of the acetabulum. The femoral head coverage may beparticularly useful in detecting an osteophyte that contributes toacetabular dysplasia or pincer impingement, and may also be used whenresurfacing the acetabular rim due to pincer impingement. In anotherexample, the sourcil angle may be used to characterize theangle-dependent coverage of the femoral head by the acetabulum. Thesourcil angle (e.g., Tonnis angle) is defined as the angle formedbetween a horizontal line and a line extending from the medial edge ofthe sourcil to the lateral edge of the sourcil. The sourcil angle may beparticularly useful in detecting an osteophyte that contributes toacetabular dysplasia, acetabular instability, or femoral impingement. Inanother example, the acetabular angle may be used to characterize theacetabular inclination or opening. The acetabular angle may include theacetabular angle of Sharp, defined as the angle formed between ahorizontal line and a line from the teardrop to lateral acetabulum. Theacetabular angle may include the acetabular roof angle of Tonnis,defined as the angle formed by a horizontal line connecting bothtriradiate cartilages (e.g., the Hilgenreiner line) and a second lineconnecting the acetabular roofs. The acetabular angle may beparticularly useful in detecting an osteophyte that contributes topincer impingement. Once the osteophyte identifier module 62 analyzesthe bone geometry to identify the osteophyte, the geometric features maybe used by the resurfacing navigator 63 to achieve a desired geometricgoal or to correspond with a preoperatively planned geometric goal. Forexample, the osteophyte identifier module 62 may identify the alphaangle, which may be used by the resurfacing navigator 63 to achieve adesired alpha angle or to correspond with a preoperatively planned alphaangle.

In an embodiment, the osteophyte identifier module 62 may analyze thebone model directly, such as by generating a 3D model based on the bonemodel and determining an impingement-free range of motion. For example,the osteophyte identifier module 62 may perform 3D reconstruction alongthe neck of the femur, identify the center of the sphere of the femoralhead, and identify the non-spherical portions to determineimpingement-free range of motion. Accordingly, the osteophyte identifiermodule 62 virtually segments the native bone surface from theosteophyte, by defining a 3D boundary surface between the native boneand the osteophyte.

In the model generated by the osteophyte identifier module 62, the 3Dboundary surface is affixed and surrounded by the 3D bone model of thebone model generator module 61. The osteophyte identifier module 62 mayalternatively or supplementally require the assistance of an operator.For instance, the 3D boundary surface based on the bone atlas data B2may be a starting point for an operator to perform adjustments to thevirtual segments or other virtual boundaries. As another example, theosteophyte identifier module 62 may provide the bone model to the bonemodel generator module 61, along with interactive virtual tools, for anoperator to define a 3D boundary surface between the osteophyte and thenative bone surface. The interactive virtual tool may include asuggested 3D boundary surface based on extensions of the native bonesurrounding the osteophytes.

A resurfacing navigator 63 uses the bone model with 3D boundary surfaceto generate the navigation file C. The navigation file C may include thebone model with 3D boundary surface, with a high enough surfaceresolution of native bone surface surrounding the 3D boundary surfacefor an intraoperative registration to be executed by the robot arm 20,in a calibration. The calibration may include the bone model B of thepatient, for surface matching to be performed by a registration pointerof the robot arm 20. The robot arm 20 would obtain a cloud of bonelandmarks of the exposed bones, to reproduce a 3D surface of the bone.The 3D surface would then be matched to the bone model B of the patient,to set the 3D model in the {X Y Z} coordinate system. If a bone model isnot available, a bone model may be generated intraoperatively. Forexample, a surgical registration pointer may be used to contact a bonesurface to register a point, and multiple points may be synthesized togenerate a cloud of small surfaces representing an approximate bonemodel.

The resurfacing navigator 63 may also include a resurfacing path for therobot arm 10 based on a model of the osteophyte, and an identificationof the tool that may be used, such as the burr 26A shown in FIG. 1 . Theresurfacing path may consider the surrounding soft tissue to beminimally invasive, such as by defining a safety zone to avoid specificsoft tissues. The resultant navigation file C defines the maneuvers tobe performed by the robot arm 20 as directed by the controller 50 of thesystem 10. The resultant navigation file C may include apatient-specific numerical control data, such as anatomical informationspecific to the patient to aid in navigating the robot arm 20. Themaneuvers may be performed by the robot arm 20 without surgeonintervention.

FIG. 5 illustrates a flow chart showing a robotized surgery systemtechnique 80 for FAI resurfacing, in accordance with some embodiments.In an embodiment, technique 80 is performed autonomously by a robotizedsystem for femoroacetabular impingement resurfacing. The robotizedsystem may include one or more of the components of the robotizedsurgery system 10 described above, such as robotized surgery controller50, robotic arm 20, tracking system 70, or other component. Inparticular, the robotized surgery controller 50 may include an FAIresurfacing controller 60, which may include a bone model generator 61,an osteophyte identifier 62, and a resurfacing navigator 63. Technique80 may include receiving 81 a bone imaging data set at a bone modelgenerator 61. The bone imaging data set may include an x-ray image, acomputed tomography (CT) scan image, MRI imaging, or any otherradiography imagery that can provide sufficient detail to allowidentification of osteophytes. The bone model generator 61 may generate82 a resurfacing model. The resurfacing model may include at least oneosteophyte and a native bone surface surrounding the at least oneosteophyte. As discussed above, generating 82 the resurfacing model canoptionally include manual intervention through a graphical userinterface provided to a surgeon or technician. The osteophyte identifier62 may map 83 a virtual 3D boundary surface based on the resurfacingmodel. The virtual 3D boundary surface may identify an osteophytevirtual boundary located between the native bone surface and the atleast one osteophyte. The resurfacing navigator 63 may generate 84 anavigation file. The navigation file may include the resurfacing model,the virtual 3D boundary surface, and a plurality of patient-specificnumerical control data. The navigation file can include control vectorsused by the surgery controller 50 to direct a cutting tool attached tothe robotic arm 20 to remove the identified osteophytes. The surgerycontroller 50 may execute the navigation file to direct the robotic armin automatically removing 85 the at least one osteophyte from the nativebone surface based on the navigation file. Removing 85 the at least oneosteophyte may include the surgery controller 50 receiving 86 trackingdata from a tracking system 70. The surgery controller 50 may furtherdirect the cutting tool attached to the robotic arm 20 based on trackingdata received from the tracking system 70. Regardless of whether atracking device is used, the robotic arm may remove 85 the at least oneosteophyte without surgeon intervention. In an embodiment, the surgerycontroller 50 may generate or update a 3D model based on tracking datareceived 86 from the tracking system 70 to verify osteophyte removal.For example, the surgery controller 50 may update the 3D model toconfirm the current state of the resurfaced bone providesimpingement-free range of motion. In addition to the surgery controller50 verifying osteophyte removal, a surgeon may manipulate a jointintraoperatively and provide osteophyte removal confirmation or otherfeedback to the surgery controller 50.

FIG. 6 illustrates generally an example of a block diagram of a machine100 upon which any one or more of the techniques (e.g., methodologies)discussed herein may perform in accordance with some embodiments. Inalternative embodiments, the machine 100 may operate as a standalonedevice or may be connected (e.g., networked) to other machines. In anetworked deployment, the machine 100 may operate in the capacity of aserver machine, a client machine, or both in server-client networkenvironments. The machine 100 may be a personal computer (PC), a tabletPC, a personal digital assistant (PDA), a mobile telephone, a webappliance, a network router, switch or bridge, or any machine capable ofexecuting instructions (sequential or otherwise) that specify actions tobe taken by that machine. Further, while only a single machine isillustrated, the term “machine” shall also be taken to include anycollection of machines that individually or jointly execute a set (ormultiple sets) of instructions to perform any one or more of themethodologies discussed herein, such as cloud computing, software as aservice (SaaS), other computer cluster configurations.

Examples, as described herein, may include, or may operate on, logic ora number of components, modules, or like mechanisms. Such mechanisms aretangible entities (e.g., hardware) capable of performing specifiedoperations when operating. In an example, the hardware may bespecifically configured to carry out a specific operation (e.g.,hardwired). In an example, the hardware may include configurableexecution units (e.g., transistors, circuits, etc.) and a computerreadable medium containing instructions, where the instructionsconfigure the execution units to carry out a specific operation when inoperation. The configuring may occur under the direction of theexecutions units or a loading mechanism. Accordingly, the executionunits are communicatively coupled to the computer readable medium whenthe device is operating. For example, under operation, the executionunits may be configured by a first set of instructions to implement afirst set of features at one point in time and reconfigured by a secondset of instructions to implement a second set of features.

Machine (e.g., computer system) 100 may include a hardware processor 102(e.g., a central processing unit (CPU), a graphics processing unit(GPU), a hardware processor core, or any combination thereof), a mainmemory 104 and a static memory 106, some or all of which may communicatewith each other via an interlink (e.g., bus) 108. The machine 100 mayfurther include a display unit 110, an alphanumeric input device 112(e.g., a keyboard), and a user interface (UI) navigation device 114(e.g., a mouse). In an example, the display unit 110, alphanumeric inputdevice 112 and UI navigation device 114 may be a touch screen display.The display unit 110 may include goggles, glasses, an augmented reality(AR) display, a virtual reality (VR) display, or another displaycomponent. For example, the display unit may be worn on a head of a userand may provide a heads-up-display to the user. The alphanumeric inputdevice 112 may include a virtual keyboard (e.g., a keyboard displayedvirtually in a VR or AR setting.

The machine 100 may additionally include a storage device (e.g., driveunit) 116, a signal generation device 118 (e.g., a speaker), a networkinterface device 120, and one or more sensors 121, such as a globalpositioning system (GPS) sensor, compass, accelerometer, or othersensor. The machine 100 may include an output controller 128, such as aserial (e.g., universal serial bus (USB), parallel, or other wired orwireless (e.g., infrared (IR), near field communication (NFC), etc.)connection to communicate or control one or more peripheral devices.

The storage device 116 may include a machine readable medium 122 that isnon-transitory on which is stored one or more sets of data structures orinstructions 124 (e.g., software) embodying or utilized by any one ormore of the techniques or functions described herein. The instructions124 may also reside, completely or at least partially, within the mainmemory 104, within static memory 106, or within the hardware processor102 during execution thereof by the machine 100. In an example, one orany combination of the hardware processor 102, the main memory 104, thestatic memory 106, or the storage device 116 may constitute machinereadable media.

While the machine readable medium 122 is illustrated as a single medium,the term “machine readable medium” may include a single medium ormultiple media (e.g., a centralized or distributed database, orassociated caches and servers) configured to store the one or moreinstructions 124.

The term “machine readable medium” may include any medium that iscapable of storing, encoding, or carrying instructions for execution bythe machine 100 and that cause the machine 100 to perform any one ormore of the techniques of the present disclosure, or that is capable ofstoring, encoding or carrying data structures used by or associated withsuch instructions. Non-limiting machine readable medium examples mayinclude solid-state memories, and optical and magnetic media. Specificexamples of machine readable media may include: non-volatile memory,such as semiconductor memory devices (e.g., Electrically ProgrammableRead-Only Memory (EPROM), Electrically Erasable Programmable Read-OnlyMemory (EEPROM)) and flash memory devices; magnetic disks, such asinternal hard disks and removable disks; magneto-optical disks; andCD-ROM and DVD-ROM disks.

The instructions 124 may further be transmitted or received over acommunications network 126 using a transmission medium via the networkinterface device 120 utilizing any one of a number of transfer protocols(e.g., frame relay, internet protocol (IP), transmission controlprotocol (TCP), user datagram protocol (UDP), hypertext transferprotocol (HTTP), etc.). Example communication networks may include alocal area network (LAN), a wide area network (WAN), a packet datanetwork (e.g., the Internet), mobile telephone networks (e.g., cellularnetworks), Plain Old Telephone (POTS) networks, and wireless datanetworks (e.g., Institute of Electrical and Electronics Engineers (IEEE)802.11 family of standards known as Wi-Fi®, as the personal area networkfamily of standards known as Bluetooth® that are promulgated by theBluetooth Special Interest Group, peer-to-peer (P2P) networks, amongothers. In an example, the network interface device 120 may include oneor more physical jacks (e.g., Ethernet, coaxial, or phone jacks) or oneor more antennas to connect to the communications network 126. In anexample, the network interface device 120 may include a plurality ofantennas to wirelessly communicate using at least one of single-inputmultiple-output (SIMO), multiple-input multiple-output (MIMO), ormultiple-input single-output (MISO) techniques. The term “transmissionmedium” shall be taken to include any intangible medium that is capableof storing, encoding, or carrying instructions for execution by themachine 100, and includes digital or analog communications signals orother intangible medium to facilitate communication of such software.

Various Notes & Examples

Each of these non-limiting examples may stand on its own, or may becombined in various permutations or combinations with one or more of theother examples.

Example 1 is a femoroacetabular impingement resurfacing systemcomprising: a bone model generator to receive a bone imaging data setand generate a resurfacing model based on the bone imaging data set, theresurfacing model including at least one osteophyte and a native bonesurface connected to the at least one osteophyte; an osteophyteidentifier to map a virtual 3D boundary surface based on the resurfacingmodel, the virtual 3D boundary surface identifying an osteophyte virtualboundary located between the native bone surface and the at least oneosteophyte; a resurfacing navigator to generate a navigation file, thenavigation file including the resurfacing model and the virtual 3Dboundary surface, the navigation file to provide control instructions toresurface the native bone surface to remove the at least one osteophyte;and an osteophyte removal device to automatically resurface the nativebone surface based on the navigation file.

In Example 2, the subject matter of Example 1 optionally includeswherein the osteophyte removal device includes an osteophyte removaltool, a robotic arm, and a robotic controller; and wherein the roboticcontroller executes the navigation file to cause the robotic arm tomaneuver the osteophyte removal tool to automatically resurface thenative bone surface to remove the at least one osteophyte.

In Example 3, the subject matter of Example 2 optionally includeswherein the navigation file includes a safety zone, the safety zonerepresenting a plurality of virtual boundaries that prevent movement ofthe osteophyte removal device into a plurality of surrounding softtissues, and wherein the robotic controller uses the navigation file tocause the osteophyte removal device to avoid the safety zone whenresurfacing the native bone surface.

In Example 4, the subject matter of any one or more of Examples 1-3optionally include a tracking apparatus to generate tracking data,wherein the robotic controller processes the tracking data to determinea location of at least one of the osteophyte removal device and thenative bone surface.

In Example 5, the subject matter of Example 4 optionally includeswherein the tracking apparatus includes an image capture device togenerate image data; and wherein the robotic controller processes theimage data to identify and determine the location of at least one of theosteophyte removal device and the native bone surface.

In Example 6, the subject matter of any one or more of Examples 4-5optionally include wherein the tracking apparatus includes a robotictracking arm to position the image capture device; and wherein therobotic controller executes the navigation file to control the robotictracking arm to improve an image quality of the generated image data.

In Example 7, the subject matter of any one or more of Examples 1-6optionally include a bone atlas database, wherein the osteophyteidentifier is further operable to: compare the bone imaging data setagainst the bone atlas database to find a closest bone atlas entry; anduse the closest bone atlas as a model for the native bone surface and toidentify the at least one osteophyte.

In Example 8, the subject matter of Example 7 optionally includeswherein the osteophyte identifier identifying the at least oneosteophyte includes identifying geometric features based on the boneimaging data set.

In Example 9, the subject matter of any one or more of Examples 1-8optionally include wherein the osteophyte identifier is further to:generate a 3D bone model based on the bone imaging data set; anddetermine an impingement-free range of motion based on the 3D bonemodel.

In Example 10, the subject matter of Example 9 optionally includes Dbone model includes: performing a 3D reconstruction along a femoralneck; and identifying a femoral head spherical center.

In Example 11, the subject matter of Example 10 optionally includes Dbone model

Example 12 is a femoroacetabular impingement resurfacing methodcomprising: performing the following operations on a computing deviceincluding a processor and memory, the operations including: receiving abone imaging data set; generating a resurfacing model based on the boneimaging data set, the resurfacing model including at least oneosteophyte and a native bone surface connected to the at least oneosteophyte; mapping a virtual 3D boundary surface based on theresurfacing model, the virtual 3D boundary surface identifying anosteophyte virtual boundary located between the native bone surface andthe at least one osteophyte; generating a navigation file, thenavigation file including the resurfacing model and the virtual 3Dboundary surface, the navigation file to provide control instructions toresurface the native bone surface to remove the at least one osteophyte;and outputting the navigation file for use by an osteophyte removaldevice to automatically resurface the native bone surface based on thenavigation file.

In Example 13, the subject matter of Example 12 optionally includeswherein the osteophyte removal device includes an osteophyte removaltool, a robotic arm, and a robotic controller; and the method furthercomprises executing the navigation file on the robotic controller tocause the robotic arm to maneuver the osteophyte removal tool toautomatically resurface the native bone surface to remove the at leastone osteophyte.

In Example 14, the subject matter of Example 13 optionally includes theoperations further including generating a safety zone, the safety zonerepresenting a plurality of virtual boundaries that prevent movement ofthe osteophyte removal device into a plurality of surrounding softtissues; wherein the navigation file includes instructions to cause theosteophyte removal device to avoid the safety zone when resurfacing thenative bone surface.

In Example 15, the subject matter of any one or more of Examples 12-14optionally include the operations further including determining alocation of at least one of the osteophyte removal device and the nativebone surface using a tracking system.

In Example 16, the subject matter of Example 15 optionally includeswherein receiving tracking data includes receiving image data from animage capture device; and wherein the operations include processing theimage data to identify and determine the location of at least one of theosteophyte removal device and the native bone surface.

In Example 17, the subject matter of Example 16 optionally includeswherein the tracking system includes a robotic tracking arm to positionthe image capture device; and the method further comprises executing thenavigation file to control the robotic tracking arm to improve an imagequality of the received image data.

In Example 18, the subject matter of any one or more of Examples 12-17optionally include the operations further including: comparing the boneimaging data set against a bone atlas database to find a closest boneatlas entry; and use the closest bone atlas as a model for the nativebone surface and to identify the at least one osteophyte.

In Example 19, the subject matter of Example 18 optionally includeswherein identifying the at least one osteophyte includes identifyinggeometric features based on the bone imaging data set.

In Example 20, the subject matter of any one or more of Examples 12-19optionally include D boundary surface further includes: generating a 3Dbone model based on the bone imaging data set; and determining animpingement-free range of motion based on the 3D bone model.

In Example 21, the subject matter of Example 20 optionally includes Dbone model includes: performing a 3D reconstruction along a femoralneck; and identifying a femoral head spherical center.

In Example 22, the subject matter of Example 21 optionally includes Dbone model.

Example 23 is at least one machine-readable storage medium, comprising aplurality of instructions that, responsive to being executed withprocessor circuitry of a computer-controlled femoroacetabularimpingement resurfacing device, cause the device to: receive a boneimaging data set; generate a resurfacing model based on the bone imagingdata set, the resurfacing model including at least one osteophyte and anative bone surface connected to the at least one osteophyte; map avirtual 3D boundary surface based on the resurfacing model, the virtual3D boundary surface identifying an osteophyte virtual boundary locatedbetween the native bone surface and the at least one osteophyte;generate a navigation file, the navigation file including theresurfacing model and the virtual 3D boundary surface, the navigationfile to provide control instructions to resurface the native bonesurface to remove the at least one osteophyte; and output the navigationfile for use by an osteophyte removal device to automatically resurfacethe native bone surface based on the navigation file.

In Example 24, the subject matter of Example 23 optionally includeswherein the osteophyte removal device includes an osteophyte removaltool, a robotic arm, and a robotic controller; and the instructionsfurther causing the device to execute the navigation file on the roboticcontroller to cause the robotic arm to maneuver the osteophyte removaltool to automatically resurface the native bone surface to remove the atleast one osteophyte.

In Example 25, the subject matter of Example 24 optionally includes theinstructions further causing the device to generate a safety zone, thesafety zone representing a plurality of virtual boundaries that preventmovement of the osteophyte removal device into a plurality ofsurrounding soft tissues, wherein the navigation file includesinstructions to cause the osteophyte removal device to avoid the safetyzone when resurfacing the native bone surface.

In Example 26, the subject matter of any one or more of Examples 23-25optionally include the instructions further causing the device todetermine a location of at least one of the osteophyte removal deviceand the native bone surface using a tracking system.

In Example 27, the subject matter of Example 26 optionally includeswherein determining the location using a tracking system includesreceiving image data from an image capture device within the trackingsystem; and wherein the determining the location includes processing theimage data to identify and determine the location of at least one of theosteophyte removal device and the native bone surface.

In Example 28, the subject matter of Example 27 optionally includeswherein the tracking system includes a robotic tracking arm to positionthe image capture device; and the method further comprises executing thenavigation file to control the robotic tracking arm to improve an imagequality of the received image data.

Example 134 is at least one non-transitory machine-readable mediumincluding instructions for operation of a robotic arm, which whenexecuted by at least one processor, cause the at least one processor toperform operations of any of the methods of Examples 1-28.

Example 135 is a method for performing any one of examples 1-28.

Method examples described herein may be machine or computer-implementedat least in part. Some examples may include a computer-readable mediumor machine-readable medium encoded with instructions operable toconfigure an electronic device to perform methods as described in theabove examples. An implementation of such methods may include code, suchas microcode, assembly language code, a higher-level language code, orthe like. Such code may include computer readable instructions forperforming various methods. The code may form portions of computerprogram products. Further, in an example, the code may be tangiblystored on one or more volatile, non-transitory, or non-volatile tangiblecomputer-readable media, such as during execution or at other times.Examples of these tangible computer-readable media may include, but arenot limited to, hard disks, removable magnetic disks, removable opticaldisks (e.g., compact disks and digital video disks), magnetic cassettes,memory cards or sticks, random access memories (RAMs), read onlymemories (ROMs), and the like.

What is claimed is:
 1. An acetabular labrum repair method comprising:performing the following operations on a robotized surgery controllerdevice including a processor and memory, the operations including:receiving acetabular tracking data from an acetabular trackingapparatus; detecting an unhealthy acetabular labrum based on theacetabular tracking data; and controlling a robotized acetabular labrumrepair device to repair the unhealthy acetabular labrum.
 2. The methodof claim 1, further including controlling a robotized cannula placementdevice to place a cannula in a predetermined location to facilitate therepair of the unhealthy acetabular labrum.
 3. The method of claim 2,wherein: the robotized cannula placement device includes a robotizedrepair device arm to position the robotized acetabular labrum repairdevice; and the operations further include controlling the robotizeddevice arm to facilitate the repair of the unhealthy acetabular labrum.4. The method of claim 1, wherein the acetabular tracking apparatusincludes an arthroscopic camera to generate the acetabular trackingdata.
 5. The method of claim 4, wherein: the acetabular trackingapparatus is attached to a robotized tracking device arm to position theacetabular tracking apparatus; and the operations further includecontrolling the robotized tracking device arm to improve an imagequality of the acetabular tracking data.
 6. The method of claim 1, theoperations further including: receiving surgery apparatus tracking datafrom a robotized surgery tracking apparatus; and determining a locationof the robotized acetabular labrum repair device based on the surgeryapparatus tracking data.
 7. The method of claim 6, wherein: the surgeryapparatus tracking data includes apparatus image data; and theoperations further include processing the apparatus image data toidentify and determine the location of the robotized acetabular labrumrepair device.
 8. The method of claim 1, the operations furtherincluding generating a safety zone, the safety zone representing aplurality of virtual boundaries that prevent movement of the robotizedacetabular labrum repair device into a plurality of surrounding softtissues; wherein the controlling of the robotized acetabular labrumrepair device includes causing the robotized acetabular labrum repairdevice to avoid the safety zone when repairing the unhealthy acetabularlabrum.
 9. An acetabular labrum repair system comprising: an acetabulartracking apparatus to generate acetabular tracking data; an acetabularlabrum repair device; and a robotized surgery controller to: detect anunhealthy acetabular labrum based on the acetabular tracking data; andcause the acetabular labrum repair device to repair the unhealthyacetabular labrum.
 10. The system of claim 9, further including arobotized cannula placement device, the robotized surgery controllerfurther to control the robotized cannula placement device to place acannula in a predetermined location to facilitate the repair of theunhealthy acetabular labrum.
 11. The system of claim 10, wherein: therobotized cannula placement device includes a robotized repair devicearm to position the robotized acetabular labrum repair device; androbotized surgery controller is further to control the robotized devicearm to facilitate the repair of the unhealthy acetabular labrum.
 12. Thesystem of claim 9, wherein the acetabular tracking apparatus includes anarthroscopic camera to generate the acetabular tracking data.
 13. Thesystem of claim 9, wherein: the acetabular tracking apparatus isattached to a robotized tracking device arm to position the acetabulartracking apparatus; and the robotized surgery controller is further tocontrol the robotized tracking device arm to improve an image quality ofthe acetabular tracking data.
 14. The system of claim 9, furtherincluding a robotized surgery tracking apparatus to generate surgeryapparatus tracking data, the robotized surgery controller further todetermine a location of the robotized acetabular labrum repair devicebased on the surgery apparatus tracking data.
 15. The system of claim14, wherein: the surgery apparatus tracking data includes apparatusimage data; and the robotized surgery controller further to process theapparatus image data to identify and determine the location of therobotized acetabular labrum repair device.
 16. The system of claim 9,the robotized surgery controller further to: generate a safety zone, thesafety zone representing a plurality of virtual boundaries that preventmovement of the robotized acetabular labrum repair device into aplurality of surrounding soft tissues; and cause the robotizedacetabular labrum repair device to avoid the safety zone when repairingthe unhealthy acetabular labrum.
 17. At least one non-transitorymachine-readable storage medium, comprising a plurality of instructionsthat, responsive to being executed with processor circuitry of acomputer-controlled robotized surgery controller device, cause thedevice to: receive acetabular tracking data from an acetabular trackingapparatus; detect an unhealthy acetabular labrum based on the acetabulartracking data; and control a robotized acetabular labrum repair deviceto repair the unhealthy acetabular labrum.
 18. The non-transitorymachine-readable storage medium of claim 17, the instructions furthercausing the device to control a robotized cannula placement device toplace a cannula in a predetermined location to facilitate the repair ofthe unhealthy acetabular labrum, wherein: the robotized cannulaplacement device includes a robotized repair device arm to position therobotized acetabular labrum repair device; and the instructions furthercausing the device to control the robotized device arm to facilitate therepair of the unhealthy acetabular labrum.
 19. The non-transitorymachine-readable storage medium of claim 17, wherein: the acetabulartracking apparatus includes an arthroscopic camera to generate theacetabular tracking data; the acetabular tracking apparatus is attachedto a robotized tracking device arm to position the acetabular trackingapparatus; and the instructions further causing the device to controlthe robotized tracking device arm to improve an image quality of theacetabular tracking data.
 20. The non-transitory machine-readablestorage medium of claim 17, the instructions further causing the deviceto: receive surgery apparatus tracking data from a robotized surgerytracking apparatus; determine a location of the robotized acetabularlabrum repair device based on the surgery apparatus tracking data; andprocess apparatus image data within the surgery apparatus tracking datato identify and determine the location of the robotized acetabularlabrum repair device.